Patient-Provider Communication: The Effect of Race and Ethnicity on Process and Outcomes of Healthcare

Compelling evidence documents racial, ethnic, and social disparities in healthcare in the United States. While many studies have focused on technical aspects of healthcare—including the receipt of certain tests, procedures, and therapies— a smaller number of studies have focused on differences in interpersonal aspects of healthcare that may contribute to disparities across a wide range of conditions. Our goal in writing this paper is to further our understanding of ethnic disparities in health outcomes through an investigation of the interpersonal processes related to the provision of healthcare. We have found that an array of social factors in addition to race—including gender, age, literacy, social class, health status, and the normative expectations that guide the therapeutic relationship— are not only relevant, but central to an understanding and appreciation of the role of ethnicity in the interpersonal dynamics of healthcare. Consequently, our review places issues of race and its consequence for patient-provider communication within this broadened context. Recent empirical studies of communication reveal interesting and unexpected results. Actual use of patient-centered communication skills identified in audiotape analysis differs by patient and physician race and ethnicity. However, patient reports of the communication experience are inconsistent with the empirical record, suggesting that both provider beliefs and attitudes towards patients as well as patient expectations and judgments of physicians are in operation. We provide the following considerations for future research. First, more indepth exploration of social cognitions and stereotyping behavior by patients, phy sicians, and other healthcare providers is needed. The reciprocal nature of the patient-physician relationship is a critical factor that should be highlighted in future work. Studies of race-concordant, patient-provider relationships will provide opportunities to increase our understanding of the constructs of cultural competence. Inasmuch as physician ethnicity is confounded with age and gender (minority physicians are more likely to be female and younger than white physicians), future research will require disentanglement of the complex interactions among patient and physician age, gender, and ethnicity, and their impact on patient-physician communication. Finally, future research should include healthcare providers who are not physicians and ethnic minority groups other than African Americans. The challenge in transforming the practice of medicine to more effectively meet the needs of ethnically diverse patients will include the generation of racial and ethnic-neutral social norms regarding patient expectations and judgments of physician conduct, as well as the establishment of medical practice norms that value communication skills, interpersonal sensitivity, and cultural competence. Increasing diversity in the physician workforce will help contribute to a societal norm that does not inherently define “doctor” in gender or race-linked terms, but this will not be sufficient to transform medical practice. Until we have more evidence as to the impact of institutional resources in improving cultural competency we must rely on physician training in interpersonal skills that emphasize those aspects of communication identified with documented benefits on patient health (e.g., patient-centeredness) coupled with patient activation and empowerment strategies as promising vehicles to improve quality of care and outcomes and reduce ethnic disparities in interpersonal aspects of healthcare.